▪︎ Case Study: Did this nurse act with “Deliberate Indifference” in her care and treatment of the patient? – With both legal and medical insights.

Wisconsin prison nurse (Becky RN) was sued in federal court under 42 U.S.C. §1983 for “deliberate indifference” to a serious medical need, following a prisoner’s ruptured appendix. The case provides valuable insight into legal risks, standards of care, and best practices for nurses — especially in correctional health settings (but other settings as well).

🧾 Nursing Case Facts

• February 13, 2018: Nurse Becky assessed inmate A.W. after he reported severe abdominal pain, vomiting, and nausea. Her nursing assessment was as follows:

🩺 Clinical Nursing Assessment

• Presenting Symptoms: Severe nausea, vomiting, 10/10 abdominal pain
• Pain Location: Generalized (epigastric); no lower quadrant complaint
• Vital Signs: Normal (no fever, BP and HR within range)
• Assessment: Abdomen soft, non-tender, normal bowel sounds
• Impression: Likely viral gastroenteritis or dehydration
• Interventions:
  • Acetaminophen and Pepto-Bismol
  • Oral hydration / clear-liquid diet
  • Scheduled follow-up
    
    
• February 14, 2018: A.W. returned to the medical clinic the next day with localized lower right quadrant pain and guarding (classic symptoms of appendicitis.)
  • Nurse Becky immediately suspected appendicitis and notified the facility, the physician, and arranged for an emergency hospital transfer.
  • The patient had emergency surgery for a ruptured appendix.
  • He later required treatment for an abscess and pleural effusion

🗣️ Deposition & Trial Testimony

• Pre‑trial: A.W. alleged that he had informed Nurse Becky on February 13 that his pain was in the lower right quadrant, believing it was appendicitis.
  
  
• Nurse Becky’s deposition (and trial): she testified that A.W. only reported general stomach pain above the navel; his vitals were within normal limits, and no signs pointed toward appendicitis.

🔍 Trial Testimony: A.W. ’s February 13 Claim (Location of Pain)

During cross-examination, defense counsel confronted A.W.  about his complaint location:

Q: “You never told Ms. Nurse Becky that you had pain on your lower right side on Tuesday [February 13]; correct?”
A: “Right.”

Q: “Because the pain on Tuesday was in your stomach; correct?”
A: “Yes.”

Q: “But the next day on Wednesday, February 14th, your pain moved to the right side?”
A: “Yes.”

This clear and consistent testimony directly contradicted A.W. ’s earlier position that he reported localized pain on Feb 13.

⚖️ Key Legal Issues

1. 🧠 “Deliberate Indifference” (8th Amendment Constitutional claim)

• Standard: The plaintiff alleged both ordinary negligence and “deliberate indifference” under the constitutional prohibition against “cruel and unusual punishment”.  A health care provider can be found liable if they are “aware of and disregard an excessive risk to a patient’s health or safety.” While this type of claim is specific to incarcerated individuals, it is similar to criminal charges brought against healthcare providers for a conscious “disregard of the risks”, such as the case of Radonda Vaught RN.
  
• Application: The court found no evidence that Nurse Becky ignored clear signs of a serious condition on Feb 13, and acted within her scope, based on symptoms and normal clinical findings at the time.

Takeaway: Healthcare providers are not liable for poor outcomes if they provide care based on what is known and observed — not what is later discovered.

2. 📋 Failure to Document or Recognize Symptoms

• A.W.  originally claimed he told Nurse Becky about lower right quadrant pain on February 13 (a red flag for appendicitis), but later admitted under oath he did not.
  
• Nurse Becky’s documentation showed no such complaint.

Takeaway: Accurate and detailed nursing documentation of symptoms, assessments, and patient education is critical. It can protect nurses from false claims or misremembered events.

3. ⛓️ Correctional Nursing Responsibility

• Nurses in prisons must make autonomous decisions and triage accurately, but they’re also dependent on:
  
  • Custody staff to relay symptoms promptly
    
  • Access to providers or hospital services

Takeaway: Correctional nurses must be vigilant—but not omniscient. They should document communication efforts and advocate for timely escalation when red-flag symptoms arise.

4. 👩‍⚕️ Nursing Standard of Care

• The courts upheld that Nurse Becky met the standard of care by:
  • Assessing within her scope
  • Responding to symptoms as they evolved
  • Referring promptly upon recognizing serious signs

Takeaway: Legal liability hinges on whether the nurse’s care matched what a reasonably competent nurse would do—not on whether the outcome was ideal.

🧾 Summary of Key Evidence

Element	A.W. ’s Position	Nurse Becky’s Position	Legal Impact
Pain location Feb 13	– Lower-right abdomen, suspected appendicitis	-General stomach pain above navel, no localization	-Central to Eighth Amendment claim
Vital signs	-Severe discomfort	-Normal vitals, soft abdomen, bowel sounds	-Supports Nurse Becky’s assessment
February 14 symptoms	-Lower right pain, guarding behavior	-Aligns with A.W.’s trial testimony	-Justified emergency referral
Expert testimony	None; A.W.  tried unsuccessfully to find one	Nurse Becky could reference standard-of-care protocols herself	Expert testimony would be critical absent direct evidence of malfeasance

Element	A.W. ’s Position	Nurse Becky’s Position	Legal Impact
Pain location Feb 13	– Lower-right abdomen, suspected appendicitis	-General stomach pain above navel, no localization	-Central to Eighth Amendment claim
Vital signs	-Severe discomfort	-Normal vitals, soft abdomen, bowel sounds	-Supports Nurse Becky’s assessment
February 14 symptoms	-Lower right pain, guarding behavior	-Aligns with A.W.’s trial testimony	-Justified emergency referral
Expert testimony	None; A.W.  tried unsuccessfully to find one	Nurse Becky could reference standard-of-care protocols herself	Expert testimony would be critical absent direct evidence of malfeasance

Other Legal Issues: Possible delay in communication between custody staff and healthcare unit. There were also allegations against the correctional staff, including that A.W. had informed correctional officers of his abdominal pain earlier (on Feb 12), resulting in a delay in his treatment.

✅ Final Lessons for Nurses and LNCs

Legal Risk	Protection Strategy
Missed diagnosis	– Assess thoroughly; escalate based on symptoms, not predictions
Alleged delay in care	– Document communication with custody & medical team
Claims of “doing nothing”	– Chart objective findings and clinical reasoning
System-level delays	– Note barriers to care and advocate for urgent response
Patient outcome worsens	– Outcome ≠ liability if care met the standard

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This case is a good example not because it shows negligence, but because it illustrates how good documentation and sound clinical judgment can protect health care providers, especially in high-risk environments.

What do you think? Share your comments and thoughts. 🙂

Laurie Elston JD BSN
www.NursingLawCenter.com
Law Office of Laurie R. Elston Inc.
📞 T: (805) 481-1001
📧 Email: Elston@charter.net